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Blood, 15 December 2007, Vol. 110, No. 13, pp. 4172-4174.
Prepublished online as a Blood First Edition Paper on October 1, 2007; DOI 10.1182/blood-2007-07-104091.
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Submitted July 31, 2007
Accepted September 17, 2007
Early peripheral blood blast clearance during induction chemotherapy for acute myeloid leukemia predicts superior relapse-free survival
Michelle Ann Elliott*, Mark R. Litzow, Louis L Letendre, Robert C Wolf, Curtis A. Hanson, Ayalew Tefferi, and Martin S Tallman
Division of Hematology/ Department of Internal Medicine, Mayo Clinic, Rochester, MN, United States
Pharmacy Services, Mayo Clinic, Rochester, MN, United States
Department ofLaboratory Medicine and Pathology, Mayo Clinic, Rochester, MN, United States
Feinberg School of Medicine, Northwestern University, Chicago, IL, United States
* Corresponding author; email: elliott.michelle{at}mayo.edu.
In childhood acute lymphoblastic leukemia (ALL), a rapid decline of circulating leukemic blasts in response to induction chemotherapy or prednisone is one of the most important prognostic factors, not only for achieving remission, but also for relapse-free survival (RFS). However, in acute myeloid leukemia (AML) parameters of chemosensitivity have been restricted mainly to the rapidity of achievement of complete remission (CR) or the assessment of residual leukemic bone marrow blasts during aplasia. We hypothesized that the time to circulating peripheral blood blast clearance, as a potential surrogate for in-vivo chemosensitivity, would have prognostic relevance in AML also. In a retrospective analysis of a cohort of eighty-six adult patients with AML receiving uniform induction and consolidation chemotherapy, we demonstrate that the time to clearance of circulating blasts during induction chemotherapy is an independent prognostic marker of RFS, superseding other known or established risk factors, including karyotype and number of inductions to achieve CR.
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